Endoscopic surgery provides many advantages over open surgery. The endoscopic procedure typically is less traumatic, can be expected to take less time and may result in a significantly shorter recuperation. The endoscope may be inserted into the patient through a natural body orifice, for example, by inserting an endoscope through the patient's mouth, through the esophagus and into the stomach. The endoscope typically has a channel through which slender instruments (e.g., cutters, biopsy forceps) can be passed to locate the distal end (inside the patient) of the instrument at the intended surgical site. The endoscope typically includes optical fiber bundles arranged to permit the physician to illuminate and view the surgical site within the patient's body. The proximal end (outside the patient) of the instrument typically is provided with controls by which the instrument can be operated to perform its intended function at the distal end.
Among the instruments adapted for endoscopic surgical use are sewing devices described in International Application No. PCT/GB95/00652. The devices are attachable to the distal end of an endoscope and are constructed to pass a suture through tissue so that the ends of the suture can be tied. The sewing devices include an arrangement by which the tissue to be sutured is drawn, by suction, into a cavity of the sewing device and, while so held, the tissue is pierced by a needle that traverses the cavity, carrying the suture through the tissue. The device includes associated mechanisms that function to separate the suture from the needle so that when the needle is withdrawn, the suture remains passed through the tissue. The ends of the suture then may be knotted with endoscopically placeable knotting instruments.
The present invention is directed to a control device, connectible to the proximal end of the endoscope and to proximally extending longitudinally moveable control elements of the sewing machine to facilitate operation of the sewing machine. One of the control elements is an elongate hollow shaft that terminates, at its distal end, in a slotted needle that pierces the tissue. The needle is adapted to carry a retention tag that is attached to one end of the suture, the suture extending out of the needle through the longitudinal slot in the needle. After the needle has been passed through the tissue, the retention tag is driven through the needle and is ejected from the distal tip of the needle by a longitudinally movable ejection wire extending through the needle shaft and needle. The ejected retention tag carries the suture with it. The sewing device includes an arrangement for capturing the retainer tag so that the end of the suture that has been passed through the tissue can be withdrawn proximally from the patient, together with the endoscope and attached sewing machine. The physician then has both ends of the suture proximally exposed to enable the suture thread to be manipulated to knot the suture at the surgical site.